Dr Luke Thomas Chiropractic Series: Issue 1 Shoulders

Mobility, stability, inhibition and compensation. These seem to be the biggest buzz words in the fitness/strength/healthcare professions at the moment, with guru like figures regularly feeding us tit bits of information that tantalize us into purchasing tickets to seminars hoping to acquire other worldly knowledge of the nervous system and human movement. We are all, including myself, suckered into this trap looking for a "magic pill" to help us "unlock the power of the nervous system" or become a "supple leopard" or some manor of other beast.

This stuff interests us, it also sells well; Personal trainers are more and more commonly giving out mobility prescriptions as part of their packages, we are rolling around on foam rollers and digging lacrosse balls into what we assume are trigger points. I hope to clear up some of this recent confusion as well as challenging some of these dangerous, naive viewpoints that seem to be taking hold in people that should know better.

I'm going to try to convince you that 90% of this is marketing sensualism and in reality most topics are pretty simple to understand when you apply some basic biomechanical logic. 

The biceps flex the elbow. The triceps extend the elbow. The infraspinatus externally rotates the humerous. All of these statements are irrefutably true, and you will be taught every single one of these in any biological science and you probably always will be, but let me challenge this for you.

Mr Richardson comes into my office, he has a rotator cuff tendonosis which he has had for months. We find that the external rotators have switched off, what do we do ? Prescribe 3x10 external rotations with a theraband, for the end of time, or until the pain fades and you stop being bothered. So what has been accomplished here? All we can hoped to have done is increase the body’s ability to perform an external rotation with a theraband, this follows the famous SAID principal (specific adaptations to imposed demands). We have not changed the speed of contraction, the global stabilization, the mobility in the thoracic spine or the stabilization in the transverse abdominis.

We have in effect done nothing to prevent his problem from reoccurring; he may as well have taken ibuprofen and waited.

"The biggest predictor of injury is previous injury"

Someone is messing up here? We have chiropractors, osteopaths, strength and conditioning coaches, physiotherapists, and rehabilitation specialists. We have a new buzz word every couple of years, core strength, functional fitness, dynamic stability. Nothing is working, people are still getting injured over and over again, patients once out of pain are discharged and sent back to the gym, only to represent weeks/months later. So what are we missing? 

Pain is the last thing to appear and the first thing to disappear, dysfunction is deviation from the ideal ROM/a lack of stability and far more pertinent to us as athletes. Mike Boyle and Gray cook have created a joint by joint approach to mobility and stability that clears up many issues for us as powerlifters/athletes.

I'll stick to the upper body as that was the example used earlier

Lumbar spine - stable

Thoracic spine- mobile

Scapulae - stabile 

Glenohumeral - mobile 

Elbow - stable 

Wrist- mobile 

Makes sense right? So let's apply this to Andrew and his rotator cuff - Andrews thoracic spine is stiff, which throws off the stability in the scapula allowing his shoulders to round which locks up his Glenohumeral joint ramming his supraspinatus tendon into his acromioclavicular arch. Now when we apply those theraband external rotations we can see they are doing pretty much nothing at all to solve the patient’s problems on a larger scale. Until the thoracic spine starts to move the scapulae will always try to compensate for it by moving in excessive and unnecessary ways never giving the Glenohumeral joint a chance to do its job. 

So once I've treated Andrew I would endeavor to check that he has sufficient motion/stability patterns before discharging him back to his sporting activity, this way I know I've done the best job possible with regards to banishing the injury long term.

This concept is fantastically elaborated on my Gray cook in "movement". Gray has developed a functional movement screen which encompasses some basic movements, including a lunge, squat, hurdle step, straight leg raise, and shoulder mobility, alongside a few others. These patterns are observed and given a quantitate score reflecting the quality of the movement. 

The author is quick to establish that this is not about spotting a "tight psoas" when viewing a lack of unilateral hip extension while lunging. This would of cause be our first thought, we may even go as far as diagnosing an "inhibited" glute, which to our clients sounds very technical and leads us onto a nice easy corrective prescription of glute bridges. However the unilateral lack of hip extension wasn't picked up on in any other movements, why? Because the glute is not inhibited and would probably test strong if we were to isolate hip extension, so why the poor patterning in the lunge? The issue is normally an asymmetry in the perceived neuromuscular stability while in a split stance, most likely causing the body to clamp down by locking up the psoas. Less easy to say and less easy to prescribe correctives for!

Finally with regard to powerlifting specifically I'll hit a few FAQ’s. Let's start with the most common pain - elbow pain. You should all know that if you load your wrist in extension you’re going to explode your flexors... So I'll skip over that. "Low bar squat position gives me bad elbow pain" "take your hands out further then" or sort the issue out and keep that desired upper back tension. So elbow pain: First we try to smash the it apart with balls, massage, ice, anti-inflammatories and general broscience, but it's not worked and you’re still getting pain. You buy a copy of ‘Becoming a Supple Leopard’, you read it cover to cover, genius it's my subscapularis, aggressive stretching of your internal rotators commences increasing the mobility at the Glenohumeral joint… great; but again it comes back. Until we chase all the way up the kinetic chain, right into the thoracic spines mobility problem, or occasionally as far down as the lumbar spine’s stability then we will never sort this elbow pain out. 

As you can see applying our basic biomechanical principals that are frequently neglected in healthcare/personal training can yield amazing results.

Information contained within this entry was taken from Gray cook’s movement, Mike Boyle and Evan Osar’s corrective exercise for the hip and shoulder.

Disclaimer: I have never treated Andrew for a rotator cuff issue! 

Written by Dr Luke Thomas Neal MChiro Chiropractor at North Down Chiropractic Clinic, Bangor. Luke frequently treats a number of local elite level power lifters in his clinic as well as members of the general public.

Luke's clinic: http://www.northdownchiro.co.uk/


I hope you all enjoyed reading this article. There will be more guest articles from now on and especially from Luke. I personally believe it is good to expand your own viewpoints and interpretations of a topic through learning off other fields of work such as Chiropractor's, Physiotherapists etc.

Thank you Luke for an enjoyable read

Andrew Richardson, Founder of Strength is Never a Weakness Blog

I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University. 

Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019. 

I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.  

My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.

My most recent publications: 

https://www.sciencedirect.com/science/article/pii/S1752928X19300216

https://www.sciencedirect.com/science/article/abs/pii/S1752928X19301076 

My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning. 

Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering. 

I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness. 

I had my own business for providing training plans for teams and athletes. 

I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships, 

in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge. 

Contact details below; 

Facebook: Andrew Richardson (search for)

Facebook Page: @StrengthisNeveraWeakness

Twitter: @arichie17 

Instagram: @arichiepowerlifting

Snapchat: @andypowerlifter 

Email: a.s.richardson@tees.ac.uk

Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278 

Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7